Tuesday, September 25, 2012

Reflections: MDT McKenzie A

This past weekend, I had the pleasure of attending my first McKenzie Method®
course (Part A) of Mechanical Diagnosis and Therapy™ (MDT). I received some
training in MDT during my courses in PT school as well as during the clinical
affiliations I had. However, this was my first formal training in MDT from the
institute itself. The following are my reflections upon this weekend’s
experience.

Coming into McKenzie Part A, I
knew it would be an introductory course to both MDT as well as the McKenzie
Method of evaluating and treating the lumbar spine. I had positive feelings coming into this
experience as I have used (admittedly) scattered MDT principles to treat (very
successfully) patients in the past. I relished the chance to learn in a more
formal and official capacity.

McKenzie Part A is a 4 day course
– 1 day online, 3 days in class. Much of the introductory material is taught
through online modules and is dived into immediately on day 2 – no lag time
whatsoever. While my understanding of the McKenzie Method is yet to be fully
matured, the immediate impression I had was that MDT utilizes a classification system
with unique language for very logical treatment approaches which require
constant clinical judgment, re-assessment, as well as solid understanding of
biomechanics (physics – Yay! No, seriously, I love physics). In my experience, most clinicians (and
patients) become nervous when they feel they are being put in a box or are
being subjected to a “cookie cutter” approach. Mechanical Diagnosis and Therapy
is FAR from a rigid, linear process and requires sensitivity to patient
symptoms, especially to nuances during patient interviews.

I really appreciated that the McKenzie
Method REQUIRES flexibility, problem solving, and creativity – all under a
systematic vector of approach. Additionally, I really enjoyed the fact that MDT
is a patient empowering approach. The course included guest patients for the McKenzie Diplomat ( Dip. MDT) instructing the course to demonstrate the MDT process – some patients came the next day so that
the students could see the rapid change in the patient’s functional status.
What impressed me was how willing the instructor was to explore painful ranges
of motion. It was genius to me once I realized that not only was this a patient
education strategy, it was also a wonderful way of ensuring that fear avoidance
behavior would not set in and begin a terrible cycle of hypersensitivity. Oh!
And, guess what? Several patients came back pain free!

I also enjoyed listening to the familiar
reprise “END RANGE!” (a la Erson Religioso’s post: “PS. End Range”)
This was a theme that I didn’t truly catch onto until I saw the instructor work
with guest patients and really … and I mean REALLY push them into end range.
From a biomechanical standpoint, it makes a lot of sense. If a disc was
posteriorly deranged, it took a lot of anterior pressure (whether repetitive or
traumatic) to derange the tissue. To reduce the derangement, wouldn’t it take a
formidable amount of reverse (posterior) pressure? Can you tell I loved the
biomechanics of MDT?!

There were other very informative
tidbits which were discussed in the course. The instructor took time to mention
certain trends in healthcare in her area of the East Coast (USA). It was
mentioned that certain insurance carriers have a separate and higher paying
billing code for credentialed MDT practitioners. Even more striking, it was
mentioned that certain insurance carriers will ONLY cover PT services if
provided by a McKenzie clinic. These happenings were said to be attributed to
MDT being shown to get patients better, faster, and for the long run. The
literature demonstrated it and the companies footing the bill want to save
their own cash – who better to see their patients than those who will help save
everyone money?

To be credentialed by the
McKenzie Institute as a clinician certified in Mechanical Diagnosis &
Therapy (Cert. MDT), one must complete McKenzie Part’s A, B, C, and D – what is
currently a 17 day program, and, additionally pass a lab/skill examination
proctored by McKenzie Diplomats (Dip. MDT). The Mechanical Diagnosis and
Therapy credential is not a weekend warrior certification. It requires a lot of
dedication.

In the end, I contemplated what I
learned. In short, my current impression is that the McKenzie Method is an
evidenced based clinical approach based on systematic evaluation, assessment,
treatment, re-assessment, and patient empowerment using a sublime utility of
low tech, high concept.

Just today, I had the opportunity
to help a patient admitted to the Emergency Department. The patient had a
history of back pain and surgery. 10 days ago, he helped a
friend build a full size pool table. Initial soreness was felt in the low back,
unfortunately, radicular pain quickly crept up until yesterday, the camel's back "broke" – the pain was so bad, walking was an
impossibility. He wanted to drive himself to the ER, however, was unable to get
out of bed. I was consulted by the physician and performed an MDT evaluation
resulting in a below knee, unilateral derangement with deformity (he had a
lateral shift to the left). Upon evaluation, this patient was unable to lift
his right leg off the bed. In fact, attempting this would cause him to scream
due to the sudden electrical sensations and pain in his low back and buttocks.
After correcting the shift and encouraging end range extension via extension in
lying, he was actually able to achieve an active straight leg raise without any
symptoms! Think I was surprised? You should’ve seen his face!

I intend on taking the rest of
the McKenzie courses and pursue credentialing. I guess you could say that MDT
has a new fan.

Great post. Our company has worked closely with the McKenzie Institute to develop repetitive endrange passive exercise table (Repex).Thought you might be interested. http://www.hilllabs.com/chiropractic/Hill-McKenzie-REPEX-Table.phpBest, Hill Laboratories